PT Prior-Auth and Denial Cost Calculator
Enter your clinic's numbers to see what prior-auth denials cost your practice each month, and how much of that is recoverable. All figures come from your inputs. The only external benchmark is HFMA: a denial rate under 5% is considered optimal; the industry average runs 5-10%.
Revenue lost to denials per month
$7,500
Recoverable revenue per month
$2,813
The share above the HFMA under-5% benchmark. Shows $0 if you are already at or below 5%.
Staff hours freed per month
21 hours
Relay's working assumption that automation removes roughly 60% of authorization time.
Revenue lost per year if nothing changes
$90,000
Physical therapy billing uses timed units under the 8-minute rule. Evaluation codes (97161-97163) are untimed per-visit codes; therapeutic procedure codes 97110 (therapeutic exercise) and 97140 (manual therapy) are timed at 15-minute units. The KX modifier is required when a Medicare beneficiary exceeds the therapy cap threshold and the clinician documents medical necessity. Source: AMA CPT.
Every figure on this page is calculated from the numbers you typed in. No dollar amount is sourced from Medicare fee schedules or any payer contract. The only external reference is the HFMA benchmark: a denial rate below 5% is optimal; 5-10% is the reported industry range. The recoverable revenue figure represents the gap between your current denial rate and that 5% floor.
Common questions.
What counts as a billable PT visit for this calculator?
Any visit where a licensed physical therapist or PTA delivers a covered service and a claim is submitted. That includes evaluation visits (97161-97163) and treatment visits billing timed codes like 97110 or 97140. Use your own payer-mix average for the revenue-per-visit input.
Why is the recoverable revenue lower than my total denial loss?
Because some denial rate is statistically unavoidable. The HFMA benchmark treats 5% as the realistic floor for a well-run practice. Recoverable revenue is only the portion above that floor, which is what better prior-auth processes can realistically target.
What does a Relay AI employee actually do with prior auth?
It handles the intake checklist, pulls the relevant clinical criteria for the payer and code, drafts the authorization request, tracks status, and flags anything that needs a licensed clinician to sign off. Your staff member reviews and finalizes. You keep the human in the loop; Relay does the bulk of the administrative lift.
Does the 60% hours-freed figure come from a published study?
No. It is Relay's working assumption based on the tasks our AI employees take on in a typical prior-auth workflow. Your actual time savings will depend on your current process, payer mix, and visit volume. Treat it as a directional estimate, not a guarantee.
See where this is leaking in your clinic
The calculator shows the gap. The free 30-minute intro call shows you which workflow an AI employee would close first.